Nurses' perception of disruptive behaviors in emergency department healthcare teams: A qualitative study.

INTRODUCTION: In an emergency setting, the occurrence of disruptive behaviors hinders team participation and cooperation. Exploring nurses' perception of disruptive behaviors can lead to a better identification of these behaviors in emergency departments and the provision of better recommendations. This study aimed to explore nurses' perception of disruptive behaviors among emergency healthcare teams in hospitals affiliated to the Hamadan University of Medical Sciences, Hamadan, Iran. METHOD: The study was carried out using qualitative content analysis in 2018-2019. Twenty participants from emergency departments of five hospitals in Hamadan, Iran, were enrolled using purposive sampling. Data were collected using semi-structured interviews that continued until data saturation. Data analysis was performed using Erlingsson and Brysiewicz's qualitative content analysis approach. RESULTS: Three main themes emerged including observable disruptive behaviors, hidden disruptive behaviors, and trigger factors. Observable disruptive behaviors consisted of two main categories: violence and incivility. Hidden disruptive behaviors included troubling behaviors, poor communication, and irresponsibility. Finally, the trigger factors of disruptive behaviors involved two categories: professional incompetency and workplace discrimination. CONCLUSION: Exploring nurses' perception showed that trigger factors such as professional incompetency and workplace discrimination could cause the occurrence of observable and hidden disruptive behaviors in emergency healthcare teams.

Hospital administration response to physician stress and burnout.

Recent studies have documented the alarming degree of physician stress and burnout that has affected physician attitudes, behaviors, and performance. Growing dissatisfaction, irritability, and frustration has negatively impacted physician ideals and attitudes which can lead to compromised health care relationships with impaired communication, collaboration, and coordination that can adversely affect satisfaction, clinical performance, and patient outcomes of care. For the most part physicians on their own have a difficult time recognizing or admitting that they are working under stress and burnout conditions, and even if they do, are reluctant to do anything about it. In this regard it is essential for the organization(s) in which the physician is involved with to take a pro- active role in providing support services to help physicians address this issue in a more empathetic, effective, and constructive manner.

Disruptive Behaviors in an Emergency Department: the Perspective of Physicians and Nurses.

Introduction: Disruptive behaviors cause many problems in the workplace, especially in the emergency department (ED).This study was conducted to assess the physician's and nurse's perspective toward disruptive behaviors in the emergency department. Methods: In this cross-sectional study a total of 45 physicians and 110 nurses working in the emergency department of five general hospitals in Bojnurd participated. Data were collected using a translated, changed, and validated questionnaire (25 item). The collected data were analyzed by SPSS ver.13 software. Results: Findings showed that physicians gave more importance to nurse-physician relationships in the ED when compared to nurses' perspective (90% vs. 70%). In this study, 81% of physicians and 52% of nurses exhibited disruptive behaviors. According to the participants these behaviors could result in adverse outcomes, such as stress (97%), job dissatisfaction and can compromise patient safety (53%), quality of care (72%), and errors (70%). Conclusion: Disruptive behaviors could have a negative effects on relationships and collaboration among medical staffs, and on patients' quality of care as well. It is essential to provide some practical strategies for prevention of these behaviors.

Strategies to Enhance Physician Engagement.

Healthcare reform and other externally driven healthcare initiatives have introduced a number of new healthcare requirements that are restructuring the way we provide healthcare services. With a growing focus on health plan efficiency and accountability for value-based performance metrics extending across the full spectrum of care, healthcare organizations are looking to develop new models of care to meet the needs of today's healthcare environment. Physician alignment and engagement are keys to success. But many physicians feel threatened, overwhelmed, and frustrated with the changes, and it's beginning to take its toll on physician attitudes and perspectives about care. Enhancing physician engagement requires a multistep process that includes making an effort to better understand their world; encouraging opportunities for input and participation in care redesign; providing education, training, guidance, and support; and making the effort to recognize and thank them for what they do.

Physician disruptive behaviors: Five year progress report.

Disruptive behaviors in health care can have a significant adverse effect on staff interactions that can negatively impact staff satisfaction, staff performance, and patient outcomes of care. As referenced in a previously published article, the Obstetrics and Gynecology specialty is one of the service areas where these behaviors occur more frequently. Despite growing evidence of the ill effects of these types of behaviors many organizations are still having a difficult time in addressing these issues in an effective manner. Gaining a better understanding of the nature, causes, and impact of these behaviors is crucial to finding the right remedies for solution. Nobody intentionally starts the day planning to be disruptive, it's just that things get in the way. A combination of deep seated factors related to age and gender preferences, culture and ethnicity, life experiences, and other events that help shape values, attitudes and personalities, and more external factors related to training, environmental pressures, stress and burnout, and other personal issues all contribute to the mix. Given the complexities of today's health care environment, each person needs to recognize the importance of being held accountable for appropriate actions and behaviors that affect work relationships and care coordination that impact patient care. Early recognition, early intervention, and taking a pro-active supportive approach to improve individual behaviors will result in better relationships, less disruption, more satisfaction, and better outcomes of care.

Taking a new approach to reduce the incidence of physician disruptive behaviors.

Disruptive behaviors continue to play a disturbing role in today's healthcare environment, negatively affecting care relationships that can adversely impact outcomes of patient care. Many organizations have implemented a number of different strategies in an effort to address this important issue with varying degrees of success. New complexities and changing roles, responsibilities and accountabilities for the delivery of appropriate, high-value, high-quality, safe, satisfying care have added increasing pressures on healthcare organizations to better integrate and coordinate healthcare delivery across the entire spectrum of care. Physicians play a crucial role in this process. When disruptive behaviors occur, rather than taking the traditional more remedial punitive approach to behavioral management, organizations would do better to try to focus on strategies that address physician and staff needs and provide appropriate supportive services to help them better adjust to stress and pressures of today's healthcare environment. Increasing levels of stress and burnout are taking their toll on physician attitudes and behaviors resulting in increasing levels of disillusionment, dissatisfaction and frustration affecting physician well-being and performance. Physicians often won't act on their own and we need to look to the organizations they are affiliated with to take the initiative by providing appropriate administrative, clinical and emotional support services before the occurrence of an unwanted event. Allowing physicians' input, listening to their concerns and providing needed support will enhance physician satisfaction, engagement, compliant attitudes and behaviors that lead to less disruption and better patient care.

Conflict resolution: unlocking the key to success.

Delivering the best care possible starts with healthcare providers. If we don't get along,what happens to our patients?

Addressing physician stress, burnout, and compassion fatigue: the time has come.

Stress, burnout, and compassion fatigue can have a significant adverse effect of physician well being and patient care. While the frequency and intensity of these negative influences appear to be increasing, there is little help available. We need to raise physician awareness as to the seriousness of this issue and at the same time gain a better understanding of some of the causative factors so we can provide the necessary support services that will enable our physicians to better adjust to the pressures and stresses of our health care environment and re-energize their zest and idealism for medical care.This is a commentary on http://www.ijhpr.org/content/2/1/31.

Addressing disruptive behaviors in the organizational setting: the win-win approach.

Disruptive behaviors can have a significant impact on organizational dynamics and work relationships and a profound negative effect on staff and patient satisfaction, performance efficiency, and patient outcomes. Despite the growing call for action, many organizations still have difficulty in addressing these issues in a consistent, effective manner. Presented below is a model that focuses on causes and barriers and offers solutions designed to promote a "What's in it for me?" win-win approach for improving morale, job satisfaction, and patient care.

Incidence and impact of physician and nurse disruptive behaviors in the emergency department.

BACKGROUND: Disruptive behaviors have been shown to have a significant negative impact on staff collaboration and clinical outcomes of patient care. Disruptive episodes are more likely to occur in high stress areas such as the Emergency Department (ED). Having the structure, process, and skills in place to effectively address this issue will lower the likelihood of preventable adverse events. OBJECTIVES: To assess the status of disruptive behaviors and staff relationships in the ED setting. METHODS: A 23-question survey tool was distributed to a regional group of ED physicians, nurses, and staff members to assess their perceptions as to the incidence of discipline-specific occurrences, types and impact of disruptive behaviors on staff behaviors, communication efficiency, and patient outcomes of care. RESULTS: A total of 370 surveys were received. Fifty-seven percent witnessed the disruptive behaviors by physicians, 52% witnessed the disruptive behaviors by nurses; 32.8% of the respondents felt that disruptive behavior could be linked to the occurrence of adverse events, 35.4% to medical errors, 24.7% to compromises in patient safety, 35.8% to poor quality, and 12.3% to patient mortality. Eighteen percent reported that they were aware of a specific adverse event that occurred as a direct result of disruptive behavior. CONCLUSION: Disruptive behaviors in the ED have a significant impact on team dynamics, communication efficiency, information flow, and task accountability, all of which can adversely impact patient care. EDs need to recognize the significance of disruptive behaviors and implement appropriate policies and protocols to address this issue.

The quality and economic impact of disruptive behaviors on clinical outcomes of patient care.

Disruptive behaviors have been shown to have a negative impact on work relationships, team collaboration, communication efficiency, and process flow, all of which can adversely affect patient safety and quality of care. Despite the growing recognition of the damage that can be done, there are still pockets of resistance to taking action to address the issue head-on. Given the new call to action from the Joint Commission accreditation standard and the growing public accountability for patient safety, organizations need to recognize the full impact of disruptive behaviors and implement appropriate policies, procedures, and educational programs to raise levels of awareness regarding the seriousness of the issue, hold individuals accountable for their behavior, and provide training and support not only to reduce the incidence and consequences of disruptive events but also to improve efficiency of communication and team collaboration in an effort to improve outcomes of care.

Managing disruptive behaviors in the health care setting: focus on obstetrics services.

Disruptive behaviors can have a significant negative impact on staff relationships, communication flow, task responsibility, and team collaboration, all of which can adversely impact patient outcomes of care. Addressing disruptive behaviors in a positive manner by emphasizing the benefits of mutual understanding, shared goals and priorities, and adherence to accepted standards of care will enhance communication flow and improve the process and outcomes of care. This is particularly relevant in the obstetrics setting, where care is delivered over a continuum of time, with multiple different members of the health care team playing a vital role as the patient progresses from labor to delivery. Critical strategies for success include having strong organizational commitment and leadership support, raising provider insight and awareness, implementing appropriate policies and procedures, providing appropriate educational and training programs, and facilitating action-oriented interventional support.

Measuring and managing the economic impact of disruptive behaviors in the hospital.

Disruptive behaviors have been shown to have a significant negative impact on staff relationships, team collaboration, communication flow, and patient outcomes of care. They can be a major factor in contributing to the occurrence of adverse events that compromise quality care and patient safety and can put the patient and organization at increased risk. Whereas organizations generally are not reticent to make system enhancements designed to improve patient safety, they are more reluctant to address human factor issues such as disruptive behaviors for a variety of reasons. This article presents a 10-step process for addressing both the economic and quality impact of disruptive behaviors in an attempt to stimulate a call to action.

Medicare's value-based payment initiatives: impact on and implications for improving physician documentation and coding.

Medicare has introduced a number of new payment initiatives that will have a profound effect on hospital reimbursement and quality and safety ratings. The new medical severity diagnosis-related group (MS-DRG) payment system adds a number of new DRG categories to more adequately account for patient severity. The new present-on-admission (POA) initiative is designed to withhold additional reimbursement for selected complications that were not recorded as being POA but that occurred during the course of the hospitalization. The recovery audit contract requires hospitals to repay Medicare for services deemed not clinically necessary based on retrospective chart review. Reimbursement and quality rankings for each of these initiatives are based on the extent and thoroughness of physician chart documentation. Physicians must understand the importance of their role and responsibilities in this process and embrace what needs to be done through appropriate education, coaching, and guidance, which leads to more effective chart documentation.

CFOs and quality managers: bridging the disconnect.

A survey of hospitals to assess the impact of selected organizational factors on achieving optimal patient outcomes found several barriers. To improve clinical and financial outcomes healthcare organizations should: Perform a self-assessment and discuss different perspectives and perceptions among stakeholders. Redesign structures and processes that support multidisciplinary input and involvement. Realign roles and responsibilities. Address problem personalities. Ensure open lines of communication among stakeholders.